Endometriosis: Pain Management for Adult Women

Management of chronic pelvic pain may require the use of several types of treatment including psychotherapy, medication, and trigger point and nerve injections. These treatments can be used in addition to laparoscopic surgery to help patients successfully manage their pain due to endometriosis.

Medication Treatment Options for Pain Symptoms

Muscle relaxing medications

• These large groups of medications work by decreasing cramping and pain in the muscles in your pelvis and around your bladder that can be caused by irritation from endometriosis.
• There are different groups of medications in this category. Examples of group names you may hear are “sedatives” or “anti-muscarinics.”
• Examples of medication names in this group: baclofen, tizanidine (Zanaflex), cyclobenzaprine (Flexeril) hyoscyamine, oxybutynin, or diazepam

Anti-depressants

• These medications can be helpful to many people with chronic pain, including nerve injury or irritation from endometriosis.
• The doses of these medications that are given to treat pain are smaller than the doses given to treat depression.
• Examples: desipramine, amitriptyline

Anti-convulsant medications

• These medications are another important category that can help women with endometriosis pain.
• The doses of these medications are much smaller than those given to prevent seizures.
• Examples: gabapentin (Neurontin), pregabalin (Lyrica), topiramate (Topamax)
• One medication in this group, topiramate (Topamax), has an extra benefit of helping with weight loss.

Interventional Therapy

Upon the discretion of a pain specialist, patients may be offered more interventional therapeutic options such as: injections to different nerves and muscles which may be diagnosed as a cause of pain. Most of these types of injections are performed in a pain clinic under direct X-ray visualization.

Nerve Blockade

This procedure may be performed for diagnostic reasons and therapeutic benefit. Results from the nerve block can be difficult to interpret thus, only a trained specialist should perform this procedure. Improvement in pain is temporary however, if the specialist feels that a patient has a good initial response, a nerve block may be considered.

Muscle injections

Patients with endometriosis tend to develop spasms in the pelvic floor, lower back and/or abdominal wall. Persistent muscle hyperactivity can lead to the development of painful trigger points which can be a secondary source of pain. Trigger points can be blocked by local anesthetic injections with or without corticosteroids. Muscle injections are also considered both a diagnostic and therapeutic procedure.

Physical Therapy

For women with pain from endometriosis, physical therapy may make up half of their treatment plan. Physical therapy is especially useful in training the muscles that line the bottom of the pelvis. This can help women learn to better control these muscles, relax them and decrease their pain.

Behavioral Therapy

Many people with endometriosis benefit from therapy to help them manage the stress, frustration and pain and that occur with this disorder. A trained therapist can be an important part of the treatment team.

Acupuncture

Some women experience significantly decreased pain with acupuncture. Often, this requires regular appointments with an acupuncturist to get longer-lasting benefit.